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Biliary Stone Extraction Could be done without EST

Thursday 19th April 2018 Back to list

Endoscopic sphincterotomy, EST, has been prevailed since early 1980S. It has replaced open surgery in most cases to extract stones from biliary tree. However, clinical researches proves that EST and endoscopic stone retraction are accompanied by 10% risk of complications, namely postoperative bleeding, perforation, long-term retrograde bile duct infection and block of basket and stone.

The risk of complication rises especially when the patients do not have cholangiectasis or other organ diseases.

During 1994 to 1999, our hospital received 20 cases (male 11 cases, female 9 cases, age from 28 to 64 , average age 41) ERCP stone extraction without EST. All received good results.

After duodenal scope inspection, we make ERCP and see the stones on bile duct. Guide wire is inserted and the dilation balloon(Wilson-Cook, model PEG-5-28-200-5-2-1, parameter 8FX8mmX20mm)is inserted as well. Observing the mark of the balloon, we place the center of balloon on the papillary sphincter. Inject gas and make dilation, under pressure 60 PSI(4ATM). Repeat the movement 2-3 times , each time 0.5-1 min.

Retreat the dilator and guide wire.  Insert the stone retrieval basket. Retrieve the stone. If the stone is taken out complete, the operation is successful.

If the stone is taken out with break stones, insert the stone extraction catheter and clean the debris.  

All the 20 patients got successful operation without any complications that always come with EST.

Five patients have serum amylase rise slightly after operation.None of the cases have  bleeding ,pancreatitis or infection.

According to our experience, dilator balloon maximum diameter is 8 mm. Decide the expansion times, duration and pressure according to the stone size. It is an effective way to extract the stone without EST for stone at choledoch and for stone size ≦ 10mm. The other advantages are low cost, short term in hospital and less complications. For young patients or patients of EST high risk, it is especially recommended.